N101 Nursing Informatics AY 2024-2025

For health consumers in the Philippines, there have been improvements in the safety and quality of care through systems like the Community Health Information and Tracking System (CHITS) and telemedicine, although challenges remain. CHITS has increased the efficiency of healthcare delivery by improving data management and record accuracy, which has benefited both patients and healthcare workers (Ongkeko et al., 2016). However, issues such as lack of standardization and inadequate infrastructure, especially in rural areas, limit its full potential. Health consumers, especially in urban areas, benefit more from these systems compared to those in the countryside where connectivity and electricity remain unreliable.

Furthermore, health care providers have been able to make more informed decisions due to these innovations. CHITS, through user-centric strategies, has empowered government health workers, streamlining processes, and improving morale. Similarly, the readiness of medical staff for telemedicine during the COVID-19 pandemic has enabled them to deliver patient care efficiently (Ang-Muñoz et al., 2022). The study from the Philippine General Hospital (PGH) highlighted that most medical staff, despite lacking prior experience, were highly accepting of telemedicine, with technological readiness directly linked to telemedicine adoption (Ang-Muñoz et al., 2022).

In addition, health managers, policymakers, and researchers have used these systems for better program development, though gaps persist. The implementation of CHITS demonstrates a successful model for community-driven health informatics, but ongoing policy and operational challenges must be addressed to scale these benefits (Ongkeko et al., 2016). Meanwhile, the PGH telemedicine study underscores the need for continued organizational and technical support to sustain its use post-pandemic (Ang-Muñoz et al., 2022). Both systems have shown promise, but further research is required to evaluate their long-term impacts on clinical outcomes and public health programs, ensuring that they can be effectively scaled and monitored across the country.

References:

• Ang-Muñoz, C. D., Leochico, C. F. D., Rayos, M. M. M., Ignacio, S. D., & Mojica, J. A. P. (2022). Readiness and Acceptance of Philippine General Hospital Medical Staff for Telemedicine as Alternative Method of Patient Consultation during the COVID-19 Pandemic and Post-enhanced Community Quarantine Period. Acta Medica Philippina, 56(4). https://doi.org/10.47895/amp.v56i4.4633
• Ongkeko, Jr., A. M., Fernandez, R. G., Sylim, P. G., Amoranto, A. J. P., Ronquillo-Sy, M.-I., Santos, A. D. F., Fabia, J. G., & Fernandez-Marcelo, P. H. (2016). Community Health Information and Tracking System (CHITS): Lessons from Eight Years Implementation of a Pioneer Electronic Medical Record System in the Philippines. Acta Medica Philippina, 50(4). https://doi.org/10.47895/amp.v50i4.769

Compared to before, there have been improvements and tangible achievements in e-health outcomes in the country. To know the current situation of Electronic Health Records, Britiller, Amponin, and Pring (2023) studied the effectiveness and challenges of EHRs in improving health outcomes. One of their findings is that EHRs have been effective in facilitating planning and continuity of care since it became easy for health providers to access patient data, which significantly reduces the time needed to find patient records compared to paper-based systems. Hence, they are able to develop appropriate care plans more quickly. However, coordination breakdowns in e-referrals still remain a concern among healthcare professionals. 

Additionally, while EHRs provide better information on medications and treatments, the study showed that EHRs alone cannot fully support patient medication compliance. Therefore, there is still a need for direct in-person communication to ensure adherence, especially since there are concerns about potential medication errors in documentation and administration.

EHRs are of big help to reduce the workload by eliminating the need for paper records and automating some tasks. However, they also introduce new tasks, such as additional charting and double-checking of information, which adds to the workload of healthcare professionals.

Challenges in having reliable internet and network connectivity also remain, affecting EHR implementation, especially in rural and underserved communities.

Reference

Britiller, M. C., Amponin, A. M., & Pring, C. C. (2023). Effectiveness and challenges: The current situation of electronic health records (EHRs) to improve health care outcomes. South East Asia Nursing Research. https://jurnal.unimus.ac.id/index.php/SEANR/article/view/12281/pdf

Various countries, including the Philippines, have recognized that implementing information and communication technology in healthcare optimizes workflow and enhances data collection, processing, and analysis. The Philippine eHealth Strategic Framework and Plan (PeHSFP) aims to shape the future health system of the Philippines and bring better health outcomes to the Filipino public. The PeHSFP goals include having safer and quality health care, aiding healthcare providers in making informed decisions, and having an effective program and research development, implementation, and monitoring. 

Several initiatives were made and contributed to the attainment of these goals. One is the development of the Community Health Information and Tracking System by UP Manila in 2004, which provided rural health units with an electronic medical record (EMR) system. This initiative made reporting easier and more efficient for the health center workers (Ongkeko, 2016). Aside from this, EMRs (e.g. RADISH in PGH) enhance decision-making and reduce errors as patient history and data can be easily accessed by healthcare providers. Moreover, the development of RxBox telemedicine by UP Manila also allowed long-distance assessment for those in disadvantaged communities and increased the quality and efficiency of the work of healthcare workers (Marcelo et al., 2022).

Despite the initiatives, challenges in attaining these goals are still present. During the COVID-19 pandemic, telemedicine was an effective tool for receiving care. However, according to Noceda et al. (2023) “negative perceptions of patients on quality of care and service related to their telemedicine provider, inherent limitations of telemedicine in the diagnosis and management of patients, perceived high costs especially for mental health conditions, and poor connectivity and other technological issues” remain as barriers to its use. As such, efforts to improve and expand these initiatives are crucial to realize the goals of the framework to ensure an equitable and responsive healthcare system for all.

References

Marcelo, P. G. F., Magtubo, K. M. M., Ang, M. A. C., Cruz, N. D., Macabasag, R. L. A., Pascual, P. J. C., Hamoy, G. L., Umali, M. J. P. S., Nisperos, G. A., Juban, N. R., Fabia, J. G., Santos-Fabia, A. D. F., Gaspar, M. J. P. O., Sison, L. G., & Pasco, P. M. D. (2022). Factors Affecting Adoption of a Telemedicine Device by Primary Care Health Workers in the Philippines. Acta Medica Philippina, 56(11). https://doi.org/10.47895/amp.vi0.3709

Noceda, A. V. G., Acierto, L. M. M., Bertiz, M. C. C., Dionisio, D. E. H., Laurito, C. B. L., Sanchez, G. A. T., & Loreche, A. M. (2023). Patient satisfaction with telemedicine in the Philippines during the COVID-19 pandemic: a mixed methods study. BMC Health Services Research, 23(1), 277. https://doi.org/10.1186/s12913-023-09127-x

Ongkeko, Jr., A. M., Fernandez, R. G., Sylim, P. G., Amoranto, A. J. P., Ronquillo-Sy, M.-I., Santos, A. D. F., Fabia, J. G., & Fernandez-Marcelo, P. H. (2016). Community Health Information and Tracking System (CHITS): Lessons from Eight Years Implementation of a Pioneer Electronic Medical Record System in the Philippines. Acta Medica Philippina, 50(4). https://doi.org/10.47895/amp.v50i4.769

Some desired eHealth outcomes have been achieved particularly benefiting healthcare providers. For instance, the computerized Registry of Admissions and Discharges or RADISH used by the Philippine General Hospital demonstrates an achieved eHealth outcome by providing the healthcare providers better access to an 'integrated view' of patients' health information. RADISH helps in facilitating efficient care coordination and more effective collaboration among the PGH healthcare team leading to better patient or health consumer outcomes. From this, we can see how beneficial eHealth is for care providers like physicians. 

However, there are gaps from the perspective of health consumers in benefiting from the desired outcomes of eHealth such as the mentioned ‘improved access to healthcare services and resources.’ Even with existing digital or electronic healthcare applications, limitation still exists especially in remote communities. Considering that many underprivileged rural or remote areas in the country struggle with signal/internet connectivity, access to electronic devices, the means, or even the knowledge about how electronic consultations work for instance which limits their ability to access the health information and services they need and should receive. 

In a study conducted by Collado, Z. (2019) in the municipality of Jomalig, Quezon Province, the author shared the struggle of the community in accessing health services due to its geographical limitations as an island. Given the country’s limitations such as in the infrastructure, resources, and manpower as mentioned in the study guide, eHealth is making progress in achieving some healthcare system goals but further improvements are still needed to ensure equitable access for ‘all’ healthcare consumers.

Reference

Collado, Z. (2019, August 1). Challenges in public health facilities and services: evidence from a geographically isolated and disadvantaged area in the Philippines. Journal of Global Health Reports, Vol. 3. https://doi.org/10.29392/joghr.3.e2019059

The Philippine eHealth Strategic Framework outlines various health system goals, each with their corresponding eHealth outcomes, which is grouped into three primary divisions and is targeted for the following stakeholders (Department of Health & Department of Science and Technology, 2013):

1. Health consumers, for safer and quality healthcare;
2. Health care providers, in making more informed decisions; and
3. Health care managers, policy makers and researchers, in effective program/research development, implementation and monitoring.

Currently, the Philippines’ healthcare system has undergone and continues to be undergoing significant progress in the digital space, as the Department of Health (DOH) leads the national policy and plans toward the rapid advancement of technology to modernize healthcare. Efforts to integrate technology in our healthcare began as early as 2009 with an attempt to legislate technology to support health services; since then, several bills followed, legislating telehealth, health passports, and other eHealth services. Moreover, the DOH saw potential in telemedicine as a way to reach areas in the country that has limited access to healthcare, thus implementing the National Telehealth Service Program (NTSP) under the Universal Health Care (UHC) (Transform Health, 2022).The National eHealth Program (NeHP) was the DOH’s initiative to address the governance and implementation challenges faced in adapting telemedicine into our healthcare (Salvio, 2024). 

Other than the DOH, various institutions have become the drivers of eHealth in the Philippines, including the 1) National Telehealth Center (NTHC) of the National Institutes of Health (NIH), University of the Philippines Manila, 2) DOH, particularly the NTSP, 3) Department of Science and Technology (DOST), and 4) Philippine Research, Education and Government Information Network (PREGINET). They have spearheaded various projects to achieve the said eHealth outcomes. The NHTC, in particular, did projects such as eLearning, eMedicine, eRecords, eSurveillance, and eHealth and eHealth policy Advocacy (Lu & Marcelo, 2021). Furthermore, the NTSP supplements the DOH’s Doctor-to-the-Barrios (DTTB) program, offering more than 350 DTTBs to implement the Telehealth services in underserved areas. The DOST, on the other hand, forefronts the integration of eHealth through the use of information and communication technologies (ICT) with projects like RxBox: Connecting medics and e-TABLET: Managing medical records (Lu & Marcelo, 2021).

Integrating eHealth in our healthcare services is crucial in achieving UHC, especially for those underserved populations in remote and less accessible areas. That said, while the eHealth outcomes may not be completely achieved, it is important that we recognize the ongoing efforts to make it palpable in our healthcare delivery system. Although its development in our country is in the early stages and lacks long-term sustainability, the literature shows progress in areas like governance, services, standards, interoperability, infrastructure, and workforce (Lu & Marcelo, 2021). There must be a coordinated national effort for the Philippines to establish a sustainable eHealth program.

References: 

Department of Health & Department of Science and Technology. (2013). Philippines eHealth Strategic Framework and Plan 2013-2017. https://cdn.who.int/media/docs/default-source/digital-health-documents/global-observatory-on-digital-health/philippines_ehealth2013_2017.pdf?sfvrsn=327c0c01_3

Lu, J. L., & Marcelo, P. G. F. (2021). Assessment of the Context for eHealth Development in the Philippines: A Work in Progress from 1997 to 2020. Acta Medica Philippina, 55(6). https://doi.org/10.47895/amp.v55i6.3208

Salvio, M. (2024, June 25). The role of technology in transforming Philippine healthcare. Springboard Philippines. https://springboard.com.ph/the-role-of-technology-in-transforming-philippine-healthcare/

Transform Health. (2022, September 6). Digital health accelerating progress to achieve UHC in the Philippines | Transform Health. https://transformhealthcoalition.org/insights/digital-health-accelerating-progress-to-achieve-uhc-in-the-philippines-2/

The Philippine eHealth Strategic Framework aimed to achieve several goals by 2020, such as ensuring widespread access to healthcare services and health information, enabling safe sharing of patient information, and transforming the utilization of information for healthcare management. There has been notable progress and significant improvements, specifically in urban areas, as evidenced by the integration of information and communication technology (ICT) in healthcare systems.

For example, the article by Marcelo et al. (2022) discussed the adoption of telehealth in rural areas, which bridges the healthcare gap for patients who face barriers such as distance or lack of mobility. Telemedicine uses ICT to assess patient information for diagnosing and treating illnesses, conducting research and evaluation, and educating healthcare professionals. Additionally, Ongkeko et al. (2016) tackled how the implementation of electronic medical records (EMR) like the Community Health Information Tracking System (CHITS) has improved patient data management and communication among healthcare providers.

Even though there has been significant progress, there are still barriers that hinder the achievement of eHealth goals, such as inadequate infrastructure in rural areas and insufficient policy enforcement. Despite progress, rural areas continue to struggle in accessing both technology and healthcare services. Efforts like the RxBox telemedicine project have tried to address these disparities, but it has been hindered by the lack of support from local governments and resource gaps (Marcelo et al., 2022). To fully achieve these goals, it is essential to address the persistent barriers by increasing investments in human resource development, especially in underserved regions.

References:

• Marcelo, P. G. F., Magtubo, K. M. M., Ang, M. A. C., Cruz, N. D., Macabasag, R. L. A., Pascual, P. J. C., Hamoy, G. L., Umali, M. J. P. S., Nisperos, G. A., Juban, N. R., Fabia, J. G., Santos-Fabia, A. D. F., Gaspar, M. J. P. O., Sison, L. G., & Pasco, P. M. D. (2022). Factors Affecting Adoption of a Telemedicine Device by Primary Care Health Workers in the Philippines. Acta Medica Philippina, 56(11). https://doi.org/10.47895/amp.vi0.3709
• Ongkeko, Jr., A. M., Fernandez, R. G., Sylim, P. G., Amoranto, A. J. P., Ronquillo-Sy, M.-I., Santos, A. D. F., Fabia, J. G., & Fernandez-Marcelo, P. H. (2016). Community Health Information and Tracking System (CHITS): Lessons from Eight Years Implementation of a Pioneer Electronic Medical Record System in the Philippines. Acta Medica Philippina, 50(4). https://doi.org/10.47895/amp.v50i4.769